A Pilot Study on Intermittent and Repeated Dosing of Ibrutinib in the Treatment of Patients With Advanced-phase Chronic Lymphocytic Leukemia (CLL)

Who is this study for? Adult patients with Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma
What treatments are being studied? Ibrutinib
Status: Recruiting
Location: See all (9) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 1/Phase 2
SUMMARY

Ibrutinib, an inhibitor of Bruton´s tyrosine kinase (BTK) is approved in CLL as continuous, daily administration of 420 mg orally until progression. Ibrutinib drug costs in health care are rapidly increasing and are difficult to predict, as long-term follow up analyses have shown that many patients remain on therapy for several years, in some cases even many years. It has been observed that patients who stop ibrutinib due to side effects may often remain with continued CLL disease control i.e. in stable partial remission even when off ibrutinib therapy. There are also emerging data on mutations within BTK, with loss of efficacy of ibrutinib, during long-term continuous administration. These observations raise the question whether alternative dosing strategies may be feasible. This pilot study will explore intermittent and repeated dosing of ibrutinib, until alternative therapy is required due to resistance or intolerance to ibrutinib. An ON-OFF dosing strategy will be applied, where advanced-phase CLL patients who have received at least 6 months of ibrutinib and who have achieved a stable PR will stop ibrutinib and be followed off therapy until clinical progression, at which ibrutinib will be re-instituted. Such ON-OFF ibrutinib cycles may be repeated until non-tolerability or resistance, or need of continuous dosing of ibrutinib (i.e. early progression when off the drug). If successful, the study will indicate a way forward towards reducing ibrutinib drug costs in health care without affecting long-term disease control, possibly also with fewer ibrutinib-related side effects due to a lower cumulative dose of ibrutinib. Long-term effects on potential mutations within BTK and its downstream signaling molecules will also be analysed.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Ability to understand and voluntarily provide written informed consent and comply with the requirements of the study.

• Age 18 years and older. There is no upper age limit in this trial.

• Able to adhere to the study visit schedule and other protocol requirements.

• Before start ibrutinib for the first time: diagnosed with CLL/SLL and active disease in need of treatment after having failed chemoimmunotherapy for CLL defined as a) refractory according to iwCLL criteria; or b) relapsed and deemed not suitable for additional chemo- or chemoimmunotherapy or c) del 17p and/or TP53 mutation irrespective of prior therapy.

• Having received at least 6 months of ibrutinib therapy and having achieved at least clinical PR according to IWCLL criteria.

• ECOG performance status of \</= 2 at screening.

• Laboratory test results:

‣ Absolute neutrophil count \>/= 0.5 x 109/L

⁃ Platelet count \>/= 30 x 109/L

⁃ Serum creatinine \< 177 µmol/L

⁃ ASAT (SGOT) and ALAT (SGPT) \>/= 2 x ULN or \>/= 5 x ULN unless attributable to CLL/SLL

• Disease free of prior malignancies for \>/= 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma in situ of the cervix or breast.

• Agree to use reliable forms of contraception. Post-menopausal females and surgically sterilized females are exempt from this criterion.

Locations
Other Locations
Norway
St Olavs Hospital
RECRUITING
Trondheim
Sweden
Falu lasarett
RECRUITING
Falun
Gävle Hospital
RECRUITING
Gävle
Sahlgrenska University Hospital
NOT_YET_RECRUITING
Gothenburg
Skåne University Hospital
NOT_YET_RECRUITING
Lund
Örebro University Hospital
RECRUITING
Örebro
Karolinska University Hospital
RECRUITING
Stockholm
Norrland's University Hospital
NOT_YET_RECRUITING
Umeå
Akademiska hospital
RECRUITING
Uppsala
Contact Information
Primary
Jeanette Lundin, MD PhD
jeanette.lundin@sll.se
0700 85 67 86
Backup
Sanna Nyström, PhD
sanna.nystrom@sll.se
08 517 759 27
Time Frame
Start Date: 2018-02-23
Estimated Completion Date: 2027-12-01
Participants
Target number of participants: 50
Treatments
Experimental: Intermittent ibrutinib
Intermittent treatment with ibrutinib.
Sponsors
Leads: Jeanette Lundin

This content was sourced from clinicaltrials.gov